1821514746 NPI number — MISS COLLEEN PATRICIA HEINZE CNM

Table of content: MISS COLLEEN PATRICIA HEINZE CNM (NPI 1821514746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821514746 NPI number — MISS COLLEEN PATRICIA HEINZE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEINZE
Provider First Name:
COLLEEN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821514746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11961-0405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-486-0832
Provider Business Mailing Address Fax Number:
631-504-0723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-4731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-486-0832
Provider Business Practice Location Address Fax Number:
631-504-0723
Provider Enumeration Date:
08/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  001814 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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